6
Chronic or Recurrent Illnesses

Chinese medicine is more effective than Western medicine
when it comes to treating most chronic conditions and
illnesses such as gastroesophageal reflux disease (GERD)

Most women do not approach the milestone of their fiftieth birthday with resounding joy. Stephanie Wilbur, however, was ecstatic. She was getting married for the first time in her life to a man she had met as a dance partner. She had wanted to find someone who could dance Cuban salsa, and word came back through friends that Morris had grown up in New York amid Puerto Rican rhythms and liked to dance the mambo, which is the basic step for South American dance. A year later, after an introduction followed by monthly ren-dezvous—where the couple would demurely meet, then spend the rest of the evening dancing hot Latin dances—they fell in love.

A frantic summer of wedding plans, a dream wedding and two weeks of glorious honeymoon behind her, Stephanie was sweating it out in Morea, French Polynesia. It was winter in the South Pacific, and flu was sweeping the island. It was a long flight home with a 102-degree fever. Inexplicably, her illness dragged on for one year, and then two. Other health problems that she had had in the past—heartburn, laryngitis, sinus infections and bronchitis—recurred with a vengeance. Ultimately, she could not work and was forced to shut down her family therapy practice. She was deeply depressed and having panic attacks that lasted for hours on end. “I was sure that I was going to die. I couldn't leave the house. I couldn't do anything.”

At fifty-six years of age, Stephanie has salt-and-pepper hair hanging halfway to her waist, penetrating brown eyes and a pleasant face. “I understand now that my wedding was a huge precipitating factor in my getting that sick,” Stephanie said. “Being married to Morris was probably the first time in my life that I ever felt safe enough to collapse.”

In the years before Morris, Stephanie had been no stranger to ill health. She had had a lifelong struggle with gastrointestinal problems, especially chronic esophageal reflux. She was conceived in the forties, “when everyone smoked and drank a lot during pregnancy and nobody cared.” An only child, Stephanie sat at the dinner table night after night under a thick blue fog of cigarette smoke as her parents fought. “There was a lot of anxiety, tension, fighting, screaming, yelling—either my mother or my father getting up and leaving the table and not coming back. I was so anxious I would eat as fast as I could. As early as six years old, I thought that it was normal to leave the table with a feeling of nausea or stomach pain. I remember having the sensation that food wasn't moving down my throat quickly enough.” On top of the gastrointestinal problems that Stephanie developed as a child in the smoke-filled home, she endured hard Eastern winters and suffered recurrent sinus infections. Taking antibiotics had become routine.

After a sterling East Coast education, Stephanie ultimately ended up dropping out in the seventies, becoming absorbed in the counterculture and living on a shoestring. She worked outside in her garden from sunup to sundown, smoking marijuana nearly every day and occasionally ingesting psychedelics. “I was trying to live a more peaceful life, and in some ways it was a good time. But there was no control over depression. I experienced bouts of anxiety that seemed never to go away. I always had stomach problems. By the time I was an adult my stomach was trashed.”

When Stephanie reentered the “establishment” her problems continued. “I had lived a relatively healthy lifestyle, eating whole, organic foods. But I didn't realize what I was doing to myself by skipping meals. I rarely sat down and ate a meal slowly. I didn't chew my food. I ate too fast. I got colds and flu more often and stayed sick longer.” Stephanie continued to suffer a range of gastrointestinal problems, including esophageal reflux, indigestion, diarrhea, constipation and bowel spasms.

Although Stephanie was plagued with a host of health problems, our focus will be on her gastroesophageal reflux disease (GERD), better known as heart-burn—a burning sensation under the breastbone that can radiate toward the throat. More than sixty million people in the United States alone—males and females of all ages, including up to 25 percent of pregnant women—suffer from GERD daily.

The physiology of esophageal reflux is fairly simple. As you chew food, enzymes within the saliva act upon it to begin the digestive process. You swallow and the food passes down into the esophagus, a muscular tube connecting the mouth to the stomach. The human stomach is a muscular, elastic, pear-shaped bag lying crosswise in the upper abdominal cavity, beneath the diaphragm. At the entrance to the stomach is a high-tension ring-shaped area called the lower esophageal sphincter, which maintains constriction to prevent the stomach's corrosive digestive juices (measuring 0.9 to 1.75 on the pH scale) from escaping into the esophagus. The pH scale, ranging from 0 to 14, is a measure of the acidity or alkalinity of a solution. For example, a hyperconcentrated solution of sulfuric acid, which is extremely acidic, would measure very low; water, which is neutral, measures 7; sodium hydroxide (lye), which is extremely alkaline, measures 14 within the pH range. The stomach's digestive juices are so powerful that if you were to drop a nail into a beaker full of digestive juices, that nail would melt down within a few hours; if you were to drink digestive juices, your mouth and esophagus would immediately erupt in burning blisters. The stomach lining, however, is protected from this low pH (highly acidic) environment by a barrier consisting of a tight layer of mucosal cells that secrete a gel-like mucus coating.

Food is churned around in the digestive juices by the muscular action of the stomach and is reduced to a semiliquid state. Then it passes through the pyloric sphincter—a ringlike muscle that relaxes, leading to the duodenum, the first section of the small intestine. In the presence of esophageal reflux—when the stomach compresses and the pressure in the stomach builds up—if the lower esophageal sphincter is too weak, the contents of the stomach (foodstuffs and the digestive juices) can backwash into the esophagus, which does not have the stomach's protective layer of mucosal cells. Repeated exposure to digestive juices can cause the lining of the esophagus to erode, become inflamed and even develop scattered ulcerations.

Stephanie had an added problem.“My food doesn't move very quickly out of my stomach, and sometimes after I've eaten, I have a burning sensation in my esophagus, which is stomach acid wanting to come up.” Peristalsis is the organized, rhythmic movement that is intended to move foodstuffs from the mouth through the digestive system—a muscular passageway with various compartments. At a sports event, when you see a stadium of people doing the wave, it is like looking at a giant digestive tract from the inside. It is likely that Stephanie's sensation of food moving sluggishly was a result of weak peristalsis. In serious cases of gastric reflux, peristalsis can actually reverse direction, carrying the stomach contents all the way up to the mouth, which Stephanie also experienced.

Stephanie tolerated her gastrointestinal problems and chalked them up as part of life. When she finally did seek medical attention in her fifties, she was given what she referred to as a “garbage-can diagnosis of irritable bowel syndrome.” Two years into her lingering illness, her asthmatic condition compelled her to seek medical attention, which included a pulmonary workup. Some individuals experience bronchial irritation when the stomach contents aspirate into the bronchial airways. Stephanie's bronchial irritation was triggered in part by esophageal spasms. Because the bronchial tree is anatomically positioned very close to the esophagus, when the esophagus is constantly irritated and goes into spasms, this can trigger the bronchus to spasm. “My doctor found nothing physically wrong with me,” Stephanie said.

Stephanie had shunned Western pharmaceuticals her entire adult life, choosing to read and study about herbs. Reluctantly, she turned to “one of the big hot industries” that have sprung up to capitalize on the landslide of chronic conditions plaguing Americans. She took all of the over-the-counter acid reflux medications, as well as prescription Zantac, Tagamet and Prilosec. Because the presence of acid in the esophagus is considered to be the cause of heartburn, the treatment focus is either to neutralize acid or to block the production of stomach acid with medications—many referred to as H2 blockers—that inhibit the activity of histamine cells that are involved in acid production. It is believed that when H2 cells are blocked, acid production diminishes.

After nine months on Prilosec, Stephanie saw no improvement. Finally, her doctor felt he had the answer: a newly discovered bacterial infection called H. pylori to which ulcers and acid conditions can often be attributed. Stephanie agreed to take a high dose of tetracycline and Flagyl. “Those are two of the most obnoxious antibiotics,” she said. “So after a ten-day course of antibiotics, whatever was left of my immune system was just wiped out.” Stephanie was deathly ill, with horrible pain in her esophagus and stomach. Her lips and mouth were on fire, her tongue an angry red from acid reflux.

At this point, a gastrointestinal specialist took Stephanie's complaint seriously. Up to 20 percent of patients diagnosed with GERD go on to develop complications such as esophageal ulcerations from chronic esophageal acid exposure and inflammation. Prolonged irritation of esophageal tissue by gastricreflux can actually change the cell makeup of the lining of the esophagus, leading to a potentially precancerous condition called Barrett's esophagus. There is a 10 percent chance of Barrett's esophagus progressing to esophageal carcinoma (it is the leading cause of esophageal cancer). The specialist examined Stephanie and ran the gamut of tests, including an endoscopy—taking a look down her esophagus with a flexible scope and snipping biopsies. “Everything was just perfect in there,” Stephanie said dryly.

Although heartburn can be triggered by behaviors that lead to diminished lower esophageal sphincter pressure—such as lying down, bending over or lifting heavy objects; eating certain foods such as chocolate, acidic foods, alcohol, caffeine or peppermint; and taking certain medications such as antiinflammatories, narcotics, tricyclic antidepressants or calcium channel blockers—Stephanie did not kid herself. “I knew anxiety was causing my esophageal reflux. Fear in and of itself is one of the worst motivators in the world. And what it does to the body is unbelievable.” Though Stephanie had never had manic episodes, she had been diagnosed as bipolar (manicdepressive) at the onset of her illness, and suffered cycles of panic, depression and anxiety. In that regard, she shared a dark legacy with her paternal grandparents. Her grandmother was schizophrenic, and her grandfather was manic-depressive. Her father, who had served as a model of anxiety, also had manic-depressive illness and had once said, “You didn't grow in a very good garden.” For Stephanie, this was bittersweet consolation.

For seventeen years of Stephanie's childhood the act of eating was associated with heightened levels of stress and anxiety. In effect, she had become conditioned. The classic study of conditioning was conducted by Russian physiologist and experimental psychologist Ivan Petrovich Pavlov, who discovered the conditioned response. Pavlov began by ringing a bell (conditioned stimulus) and presenting his dogs with food. At first the dogs salivated at the sightand scent of the food (unconditioned response). But after a number of trials the dogs salivated as soon as the bell had been rung (conditioned response) even without the presentation of food. It took a very short time for Pavlov to detect the conditioning of his dogs to the bell. Yet Stephanie went through seventeenyears of reinforced conditioning with her parents' nightly battles at the dinnertable. To her, eating is associated with stress and anxiety. Fifty years later, she may be sitting with her husband eating in a calm state, but on an unconscious level, that bell of Pavlov's dogs is still ringing. Because Stephanie had consciously sought to reverse this conditioning, when she married Morris she feltsafe enough to allow herself to fall apart so she could begin the process of reconditioning.

At the end of a fruitless two-year search through Western medicine, seeking a cure, Stephanie went to see Dr. Han, who took a completely different approach in treating Stephanie's esophageal reflux.

Western medicine is primarily focused on stomach acid and ways to block it with H2 blockers, or to neutralize it with over-the-counter agents such as Pepto-Bismol. However, stomach acid production and regulation is a complex process. One of the basic mechanisms of your body is to monitor how much acid is in your stomach. When the acid drops below a normal level, your brain releases hormones that trigger the cascade of events leading to increased production of acid. When acid production gets too high, the signal is fed back to the control center, which reduces the hormones and acid production subsides. By neutralizing or blocking the production of stomach acid, you are interfering with the body's own regulating mechanisms. When you neutralize or block acid production, your brain is going to get a signal that says, “Aha! I don't have enough stomach acid. I must make some more.” In the long run, instead of reducing stomach acid, there is the risk that the body will continue to make more and more acid. Therefore, the more you take the H2 blockers or neutralizing agents, the more likely it is that you will have to continue to take them.

In Chinese medicine the problem of acid reflux is never a problem in and of the stomach itself; rather, it involves a pattern of relationships among three critical Energetic systems: Stomach, Spleen and Liver. The interaction or interplay of these three systems provides Energy movement and circulation that is critical for the process of digestion. Normally, Stomach Energy descends and Spleen Energy ascends. In Chinese medicine, Spleen Energy represents most of the digestive functions performed by the intestines and colon. The dynamic of Spleen Energy is to extract the nutrients, then transport and distribute these nutrients throughout the body by ascending upward and outward (imagine the gentle flow of a lawn sprinkler). Liver Energy is pivotal in regulating and directing the traffic of Energy flow, ensuring that what should flow upward goes up and that what should flow downward goes down.

Imbalances within Stomach, Liver or Spleen Energy can result in gastrointestinal problems. The circulations of the descending Stomach Energy and the ascending Spleen Energy are mutually dependent on each other. Often when Stomach Energy is going in the wrong direction (backing up), you will suffer gastric reflux, nausea and vomiting. When Stomach Energy backs up, Spleen Energy tends to go in the wrong direction as well (down instead of up and outward), and you will have symptoms of gas, bloating, diarrhea and, if left untreated, likely malnutrition. This can be referred to as rebellious Stomach Qi.

Figure 20

In Western medicine esophageal reflux is one diagnosis, and people who suffer from it are pretty much treated the same way—by focusing on neutralizing or suppressing the production of acid. In Chinese medicine, the treatment for esophageal reflux does not focus solely on suppressing or neutralizing stomach acid. In fact, you can even use acid to treat acid. One of the methods Chinese medicine uses is the paradoxical approach of prescribing Sour herbs to treat gastric reflux. Putting Sour herbs into an already “sour” stomach signals the brain not to produce any more acid.

From a Chinese point of view the symptom of esophageal reflux presents a complex situation. Within this diagnosis, there are at least ten different types that can be differentiated, each with a unique Energetic pattern of imbalances. Treatment takes the form of a multitargeted approach, in which these many imbalances are addressed. In addition, each patient's particular condition must also be taken into consideration. In Western medicine it does not matter, for example, if you are a male or female, if you are strong or weak, if you tend to be hot or cold, work inside or outdoors, or if you tend to be calm or emotional. Chinese medicine factors in all of a person's individual conditions when formulating a diagnosis and treatment plan.

Defining one's type and unique condition ensures that the treatment plan will optimally agree with the patient's constitution. In Stephanie's case, one of the two major obstacles to curing her esophageal reflux was that her damaged esophageal lining could not heal because of continued exposure to the caustic contents of her stomach. The second factor was her stress.

One of the most important functions of Liver Energy is to regulate emotions. Among all the Energetic systems, Liver Energy is the most sensitive to the effects of stress. When Liver Energy is affected by stress, its ability to regulate or direct the traffic of Energy flow within the body is compromised. If Stephanie's stress is not resolved, the problem of esophageal reflux will keep recurring. It is important for her to get at the root of her stress and to manage her anxiety as best she can. Herbal treatments can aid in treating Stephanie's stress. If she does not manage her stress, Liver Energy will not be able to regulate the upward and downward flow of Stomach and Spleen Energy. These factors often make esophageal reflux a chronic condition.

Collaboration with Western medical diagnostic techniques can make a significant difference in the formulation of a Chinese herbal treatment plan. For example, if biopsy results from an endoscopy indicate precancerous changes, certain herbs will be selected to address this precancerous state and prevent the evolution to cancer. If a test for H. pylori is positive, Western medicine has antibiotics to treat this condition, but these medications can be harsh on the stomach. Using herbs to treat H. pylori is a gentler yet equally effective treatment.

Stephanie's formula included Bletilla, a primary herb that melts at body temperature, thereby creating a gel-like coating of the upper gastrointestinal (GI) tract. This insulates the damaged lining (or ulcerations) from the constant erosion and/or irritation of stomach acids, bile and digestive enzymes, allowing these tissues to heal. It also improves microcirculation in the mucosal membrane of the upper GI tract, arrests bleeding and aids in the generation of new tissue, reduces inflammation and pain, and soothes discomforts such as burning, sour feeling and bloating. Corydalis acts as a secondary herb to control pain and discomfort by promoting energy and blood circulation. Notoginseng, another secondary herb, assists Bletilla in repairing the destroyed lining of the GI tract by stimulating growth of new tissue. Notoginseng is also known for its superb ability to both promote circulation and arrest bleeding. Pearl powder is a secondary herb that has an extraordinary ability to heal membranes. Pearl powder is calming and soothing, which helps the patient cope with stress. Peony, Licorice, Bamboo shavings and Ginger were added to regulate peristalsis (so that it would function normally), and additional herbs were added to address her anxiety.

Stephanie had digestive problems as a result of weakened Spleen Energy, so she could not handle a strong herbal formula. Dr. Han prescribed granulated herbs. Another reason Dr. Han chose this particular process is that an herbal decoction from dried herbs would immediately wash down into the stomach. Granulated herbs can be dissolved in warm water to create a creamy consistency. Dr. Han instructed Stephanie to drink this creamy herbal mixture thirty minutes prior to a meal to coat her esophagus and stomach. This multilevel approach would coat her tissues to allow healing.

An important aspect of Chinese diagnosis is examining a patient's tongue. At Stephanie's first visit, Dr. Han saw on Stephanie's tongue that her problems were old and deeply rooted. This came as a relief to Stephanie. “I knew that it would take some time for me to heal and that I'd never be as pristine as I was when I was born. It's just the way it is. And it took about three months before I got any results from the granulated formula. But it felt good. I love the taste of the herbs. They don't taste like medicine—they taste like earth. It's not a bad taste. I was so relieved that something worked—three months didn't seem like a long time, compared to the years I suffered in pain and discomfort.”

Although Stephanie claims that herbs are the only treatment that ever worked for her, she deserves the credit. If she had not stuck with the herbal treatment program, she would not have seen the benefits. Stephanie's story demonstrates that in some cases healing takes patience. Stephanie's case of GERD was severe. In the vast majority of cases the inflamed lining of the esophagus can improve markedly within a couple of weeks. Small ulcerations can be healed in about a month.

The home that Stephanie has made with Morris mirrors her creativity, with an upright piano along one wall, a sewing machine set up on the dining room table and jars of herbs and spices lining the kitchen shelves. “When I went through that two-year period of illness I felt that my whole career was a sham— how could I be a therapist helping others if I was that sick? But it certainly has been a gift in many ways. As time went on I began to see that I could be a lot more help to other people. There is nothing more humbling than getting that sick and recovering. I imagine that anyone who has ever been seriously ill and recovered has discovered some compassion and humility.”

Stephanie's patience with her healing process combined with the individualized approach of Chinese medicine restored her to a more functional state. As for her gastric reflux, she said, “I'd probably have to live a monastic life in order for it not to be a problem. But Chinese herbs have made it possible for me to live a more normal life.” Including dancing with Morris.

Individualized Program for GERD

Symptoms and indications of rebellious stomach Qi/GERD

Ways to treat rebellious stomach Qi to correct or prevent GERD

Take Extra Steps to Manage Stress: If you feel you have tried everything to manage your stress and you are still stressed out, it may be time to seek professional help to resolve your emotional issues. In addition, make a habit of listening to positive visualization tapes.

Quit Smoking: Smoking irritates the esophagus, which aggravates GERD. See page 150 for more on nicotine and for guidelines to help you quit the habit.

Modify Your Diet: From the point of view of Chinese medicine, everything we take into our bodies—air, food and experiences—generates Qi (energy). Thus, to obtain balance it is necessary to make healthy choices regarding the quality of air you breathe, the circumstances you involve yourself in—and especially what you eat and ingest. In Chinese medicine, food has an Energetic dimension and should be agreeable with a person's specific condition as much as possible.

Foods That Help to Coat the Stomach

Cream of sweet rice (a glutinous rice similar to white rice, but sticky and slightly sweet)

Kudzu starch (used in place of cornstarch)

Lotus root starch (use in blended drinks or stir-fries)

Potatoes (preferably in soup)

Foods That Help to Promote Esophageal Motility

Bamboo fluid and shoots (can be used in stir-fries or tea)
Cinnamon

Dried tangerine peel (as a flavoring agent or in tea)

Ginger (use in stir-fries or tea)

Loquat fruit (can be used in desserts or eaten alone)

Foods That Help to Strengthen Digestive Energy

Chinese dates (similar to European dates)

Chinese yams (similar to American yams but not as sweet)

Hyacinth bean (medium-sized white bean, very good for digestion—prepare as you would any other bean) Licorice (use for flavoring in desserts) Pearl barley (whole grain) Poria mushroom (a bland mushroom that can be used in soup or eaten with rice)

Rice and sweet rice (see recipe on page 329)

Foods That Are Cooling and Help to Nourish Stomach Yin

Mung beans (small green bean, Cooling and detoxifying in nature—prepare as any other bean)

Dandelion greens (in stir-fries or salads) Asparagus

White wood ear mushroom (Chinese use these mushrooms to make dessert, porridge, soup or stir fry)

Lotus root (see recipe on page 329)

Lotus seed (use in pudding or sweet porridge)

Lily bulbs (fresh bulbs can be stir-fried, dried can be rehydrated and used in porridge or dessert)

Soft tofu (use in stir-fries, soup)

Foods That Are Warming and Help Invigorate Energy Flow to the Stomach

Basil Garlic (small amounts)
Cardamom Ginger
Clove Green onion
Fennel Turmeric

Foods That Help Reduce Indigestion

Dainkon radish (can be cooked or used raw in a salad)

Dried tangerine peels (use as flavoring)

Daikon radish (can be cooked or used raw in a salad) Dried tangerine peels (use as flavoring)

Foods That Help Reduce Pain

Sichuan pepper (seasoning)

Galangal (Thai ginger)

Ginger

Turmeric

Avoid Eating on the Run: Your autonomic or unconscious nervous system, which regulates the actions of your intestines, is divided into the sympathetic and the parasympathetic nervous systems. During the day, when you are awake, responding to stress, eating and running, you are predominantly in the sympathetic state. When you are in a sympathetic state, peristalsis (the organized, rhythmic muscular contractions of the digestive tract that move food from the mouth through the digestive system) is slowed down. When you eat while in this state, your digestive system cannot function properly. Slow down when you are eating. Never eat at your desk. Walk around slowly, breathing deeply, for a few minutes after meals to allow your autonomic nervous system to shift into a parasympathetic mode, which will get peristalsis moving more effectively.

Do Not Go to Bed Within Three Hours After Eating a Full Meal: Eat smaller, more frequent meals. Elevate your head and upper body six inches when sleeping or lying down, but do not lie down right after a meal, as this may cause the contents of your stomach to back up into your esophagus.

Lose Weight If You Are Overweight: Increased abdominal pressure from extra pounds increases the pressure on your esophagus and contributes to GERD. Avoid tight-fitting clothes and belts.

Nurturing a balanced lifestyle will result in healthy weight loss. Eating a balanced diet of real, whole foods can eliminate cravings. Weight loss is discussed further in chapter 19.

Chinese Herbs and Western Supplements: Avoid taking antacids on a long-term basis. The excess calcium carbonate in antacids can make your stomach too alkaline, which can actually stimulate more acid production.

Western digestive supplements can be purchased in a health food store. Routinely, before each meal, take one to three (depending on the size of your meal) enzyme capsules containing a combined total of 500 to 1,500 milligrams of the digestive enzymes lipase, amylase and protease.

Routinely, after each meal, take 600 to 1,200 milligrams of betaine hydrochloride, depending on the size of your meal. If you feel a warm, burning sensation in your stomach when taking betaine hydrochloride, drink an eight-ounce glass of water and discontinue use.

Routinely, three times a day, after meals, take 300 milligrams chewable deglycyrrhinated licorice root. Licorice root accelerates the actions of the cells that provide a protective coating of the lining of the stomach.

You can also take Chinese herbal formulas and Western supplements specifically formulated to treat GERD. Within the Western diagnosis of GERD, at least ten types can be differentiated in Chinese medicine, each with a unique Energetic pattern of imbalances. You can find patent formulas to treat each type at your local Chinese herbal clinic or online at ancientherbsmodernmedicine. com. While it is always optimal to consult a Chinese doctor and prepare herbal decoctions of formulas created specifically for you, patent formulas may be used to fill in the gap between the times when you can consult a doctor, or if a doctor is not available in your area.